2015 TAX ORGANIZER. This tax organizer has been prepared for your use in gathering the information needed for your 2015 tax return.

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Mail/Presentation Sheet - to taxpayer 500105 04-01-15

F

R

O

M

T

O

This tax organizer has been prepared for your use in gathering the information

needed for your 2015 tax return.

To save you time, selected information from your 2014 tax return has been

entered in this organizer. Please line through any information that does not

apply to your 2015 tax return.

In some cases, 2014 amounts have been included in a separate column. These

amounts are for comparison purposes only. You do not need to change these

prior year amounts.

If we may be of further assistance, please contact us at your convenience.

REMOVE THIS SHEET PRIOR TO RETURNING THE COMPLETED ORGANIZER

2015 TAX ORGANIZER

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500461 04-01-15

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500121 09-17-15 The following questions pertain to the 2015 tax year. For any question answered Yes, include supporting detail or documents.

Yes No

Did your marital status change? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Are you married? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, do you and your spouse want to file separate returns?

If No, are you in a domestic partnership, civil union, or other state-defined relationship?

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]] Can you or your spouse be claimed as a dependent by another taxpayer? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse serve in the military or were you or your spouse on active duty? ]]]]]]]]]]]]]]]]]]]]]]]]] Have you or your spouse been a victim of identity theft and have you contacted the IRS? ]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, furnish the 6-digit identity protection PIN issued to you by the IRS. Taxpayer Spouse

Were there any changes in dependents from the prior year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Note: Include non-child dependents for whom you provided more than half the support.

Did you or your spouse pay for child care while you or your spouse worked or looked for work? ]]]]]]]]]]]]]]]]]]]]] Do you have any children under age 18 with unearned income more than $1,050? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you have any children age 18 or student children, aged 19 to 23, who did not provide more than half of their cost of support

with earned income and that have unearned income of more than $1,050? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you adopt a child or begin adoption proceedings? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Are any of your dependents non-U.S. citizens or non-U.S. residents? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Did you have healthcare coverage (health insurance, including Medicare, Medicaid, CHIP, and TRICARE) for you, your spouse, and any dependents for the entire year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, include all Forms 1095-A, 1095-B, and 1095-C. If you did not receive Forms 1095-A, 1095-B or 1095-C, attach information detailing each month you, your spouse, and your dependents had coverage.

If No, there are several exemptions from the mandate requiring health insurance coverage. Examples include membership in a healthcare sharing ministry, membership in a federally recognized Indian tribe, incarceration, membership in certain religious sects, and enrollment in certain Medicaid and TRICARE programs that do not provide minimum essential coverage. If any of these provisions apply, provide information regarding

the exemption, the individual(s) (taxpayer, spouse, dependents) to which the exemption(s) may apply, and the month(s) for which the exemption(s) apply.

Are you claiming the exemption for someone having healthcare coverage purchased in the Marketplace and for

whom you did not receive Form 1095-A? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you receive Form 1095-A for someone for whom another taxpayer will claim the personal exemption on their tax return? ]]]] Did you apply for an exemption through the Marketplace? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, provide the Exemption Certificate Number.

Are any of your dependents required to file a tax return? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Personal Information:

Dependents:

Healthcare:

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500122 06-18-15

Yes No

Was anyone covered on your health insurance policy also covered on another health insurance policy for any part

of the year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Were you eligible for employer-sponsored healthcare coverage? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If you received advance premium tax credit or enrolled in coverage through the Marketplace, are married, and are

filing separately from your spouse, are you a victim of domestic abuse or spousal abandonment? ]]]]]]]]]]]]]]]]] Did you or your spouse have any transactions pertaining to a health savings account (HSA)? ]]]]]]]]]]]]]]]]]]]]]]]

If you received a distribution from an HSA include all Forms 1099-SA.

Did you or your spouse have any transactions pertaining to a medical savings account (MSA)? ]]]]]]]]]]]]]]]]]]]]] If you received a distribution from an MSA include all Forms 1099-SA.

Did you or your spouse receive any distributions from long-term care insurance contracts? If Yes, include all Forms 1099-LTC.

]]]]]]]]]]]]]]]]]]]]]]]] If you or your spouse are self-employed, are you or your spouse eligible to be covered under an employer's health plan

at another job? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, how many months were you covered?

If you or your spouse are self-employed, are you or your spouse eligible to be covered under an employer's long-term

care plan at another job? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, how many months were you covered?

Did you or your spouse lose your job because of foreign competition and pay for your own health insurance? ]]]]]]]]]]]]]

Did you or your spouse pay any student loan interest? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse withdraw any amounts from your IRA to pay for higher education expenses incurred by you,

your spouse, your children or grandchildren? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse withdraw any amounts from a Coverdell Education Savings Account or Qualified Education

Program (Section 529 plan)? If Yes, include all Forms 1099-Q.

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you, your spouse, or your dependents incur any post-secondary education expenses, such as tuition? ]]]]]]]]]]]]]]]

Did you or your spouse contribute property (other than cash) with a fair market value of more than $5,000 to a

charitable organization? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, provide the appraisal of property contributed. An appraisal is not required for contributions of publicly

traded securities or contributions of non-publicly traded stock of $10,000 or less.

Did you or your spouse incur any casualty or theft losses? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse make any large purchases, such as motor vehicles and boats? ]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse incur any casualty or loss attributable to a federally declared disaster? ]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse purchase a new alternative technology vehicle, including a qualified plug-in electric drive motor vehicle? ]] Did you or your spouse use gasoline or special fuels for business or farm purposes (other than for a highway vehicle)? ]]]]]]]]

If Yes, provide the number of gallons of gasoline or special fuels used for off-highway business purposes.

Gallons Type

Did you or your spouse install any alternative energy equipment in your residence such as solar water heaters, solar

electricity equipment (photovoltaic) or fuel cells? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse install any energy efficiency improvements or energy property in your residence such as exterior

doors or windows, insulation, heat pumps, furnaces, central air conditioners, or water heaters? ]]]]]]]]]]]]]]]]]]]

2015

Healthcare (continued):

Education:

Deductions and Credits:

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500123 06-18-15

Yes No

Did you or your spouse have any debts canceled, forgiven or refinanced? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse start or purchase a business, rental property, or farm, or acquire any new interest in any

partnership or S corporation? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse sell an existing business, rental property, farm, or any existing interest in a partnership or

S corporation? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse sell, exchange, or purchase any real estate? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, include closing statements.

Did you or your spouse receive grants of stock options from your employer, exercise any stock options granted to you or

your spouse or dispose of any stock acquired under a qualified employee stock purchase plan? ]]]]]]]]]]]]]]]]]] Did you or your spouse engage in any put or call transactions? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, provide the transaction details.

Did you or your spouse close any open short sales? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse sell any securities not reported on Form 1099-B? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Did you or your spouse contribute to a Roth IRA or convert an existing IRA into a Roth IRA? ]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse roll into a Roth IRA any distributions from a retirement plan, an annuity plan, tax shelter annuity

or deferred compensation plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse turn age 70 1/2 and have money in an IRA or other retirement account without taking any

distribution? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse retire or change jobs? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse receive deferred, retirement or severance compensation? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, enter the date received (Mo/Da/Yr).

Did your address change? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, provide the new address.

If Yes, did you move to a different home because of a change in the location of your job? ]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse claim a homebuyer credit for a home purchased in 2008? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse withdraw any amounts from your Individual Retirement Account (IRA) or Roth IRA to acquire

a principal residence? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Are your total mortgages on your first and/or second residence greater than $1,000,000? ]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, provide the principal balance and interest rate at the beginning and end of the year.

Did you or your spouse take out a home equity loan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse have an outstanding home equity loan at the end of the year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, provide the principal balance and interest rate at the beginning and end of the year.

Are you claiming a deduction for mortgage interest paid to a financial institution and someone else received

the Form 1098? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your mortgagee receive mortgage assistance payments? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, include all Forms 1098-MA.

2015

Investments:

Retirement or Severance:

Personal Residence:

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500124 10-08-15

Yes No

Did you sell your home? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you receive Form 1099-S? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, include Form 1099-S.

Did you or your spouse own and occupy the home as your principal residence for at least two years of the five-year

period prior to the sale? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse ever rent out the property?

Did you or your spouse ever use any portion of the home for business purposes?

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]] Have you or your spouse sold a principal residence within the last two years? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] At the time of the sale, the residence was owned by the: Taxpayer Spouse Both

Did you or your spouse make any gifts, including birthday, holiday, anniversary, graduation, education savings,

etc., with a total (aggregate) value in excess of $14,000 to any individual? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse make any gifts of difficult-to-value assets (such as non-publicly traded stock)

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] to any person regardless of value?

Did you or your spouse make any gifts to a trust for any amount? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you or your spouse have a life insurance trust? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse assist with the purchase of any asset (auto, home) for any individual? ]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse forgive any indebtedness to any individual, trust or entity? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Did you or your spouse perform any work outside of the U.S. or pay any foreign taxes? ]]]]]]]]]]]]]]]]]]]]]]]]]] Were you or your spouse a grantor or transferor for a foreign trust, have any interest in or a signature

authority over a bank account, securities account or other financial account in a foreign country? ]]]]]]]]]]]]]]]]]] Did you or your spouse create or transfer money or property to a foreign trust? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse own any foreign financial assets? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Sale of Your Home:

Gifts:

Foreign Matters:

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500125 06-19-15

Yes No

Additional state pages have been included at the back of the organizer and should be reviewed.

Did you or your spouse pay in excess of $1,000 in any quarter, or $1,900 during the year for domestic services

performed in or around your home to individuals who could be considered household employees? ]]]]]]]]]]]]]]]]]] Did you or your spouse receive unreported tip income of $20 or more in any month? ]]]]]]]]]]]]]]]]]]]]]]]]]]]] Have you or your spouse received a punitive damage award or an award for damages other than for physical

injuries or illness? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse engage in any bartering transactions? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Were you or your spouse notified by the IRS or other taxing authority of any changes in prior year returns? ]]]]]]]]]]]]]]] For any trust that you or your spouse created or are trustee, did any beneficiaries, grantors, or trustees die or move? ]]]]]]]]

2015

Miscellaneous:

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Electronic Filing

Electronic filing is the means by which your return is transmitted directly to the IRS and state tax authorities. The IRS has implemented an

electronic filing mandate requiring certain preparers, including this firm, to file all returns that they prepare electronically. Some states also

require certain preparers to electronically file state returns prepared. The IRS and some states allow taxpayers to elect not to file their

returns electronically.

Do not electronically file my federal and state tax returns

Note: The IRS and some states that require returns to be electronically filed also impose fees and/or penalties for failure to do so. If you

checked the box above, you may be required to sign an "opt-out" form before we can release your returns.

Direct Deposit and Electronic Withdrawal

The IRS and certain states allow refunds to be deposited to and balances due to be paid directly from your financial institution. If you would

like to receive your refund or pay a balance due electronically, complete the following information.

Would you like any refunds owed to you directly deposited?

Yes

No

Would you like to pay any amount due using electronic withdrawal?

Yes

No

Would you like to pay any estimated payments using electronic withdrawal?

Yes

No

If you've answered yes to any of the questions above, provide the following information or attach a copy of a cancelled check:

Name of bank or financial institution . . . _________________________

Routing transit number . . . __________________________

Account number . . . __________________________

Type of account



Checking



Savings

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First Name and Initial Last Name Social Security Number

Occupation Date of Birth (Mo/Da/Yr) Date of Death (Mo/Da/Yr)

Driver's License or State-Issued ID Number Issue Date (Mo/Da/Yr) Expiration Date (Mo/Da/Yr) State

First Name and Initial Last Name Social Security Number

Occupation Date of Birth (Mo/Da/Yr) Date of Death (Mo/Da/Yr)

Driver's License or State-Issued ID Number Issue Date (Mo/Da/Yr) Expiration Date (Mo/Da/Yr) State

Street Address Apartment Number

City State ZIP or Postal Code

Foreign Province or County

Foreign Country

Taxpayer Daytime/Work Phone Spouse Daytime/Work Phone

Taxpayer Evening/Home Phone Spouse Evening/Home Phone

Taxpayer Foreign Phone Spouse Foreign Phone

Taxpayer Cell Phone Spouse Cell Phone

Taxpayer Fax Number Spouse Fax Number

Taxpayer Email Address

Spouse Email Address

Preferred Method of Contact

500131 10-13-15 Taxpayer:

Spouse:

Contact Information:

Yes No

Taxpayer Spouse

Yes No Yes No

Throughout the tax organizer, you will find columns with the heading "TSJ". Enter "T" for taxpayer, "S" for spouse or "J" for joint. Worksheets: Basic Data > General and Return Options > Processing Options

Forms 1, 1A and 2

May the IRS or other taxing authority discuss the return with the preparer? ]]]]]]]]]]]]]]]]]]]]]]]] Is the taxpayer claimed as a dependent on someone else's tax return? ]]]]]]]]]]]]]]]]]]]]]]]]]]

Are you considered legally blind per IRS regulations?

Do you want to contribute to the Presidential Election Campaign Fund?

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Tax Organizer Legend:

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500133 09-18-15 Did dependent have income over $4,000?

First Name and Initial Last Name Social SecurityNumber Date of Birth(Mo/Da/Yr) Date of Death(Mo/Da/Yr) Relationship toTaxpayer

Months Lived in Your Home

X if Disabled

Yes or No

TS Employer's Name Taxable Wages Tax Withheld

Federal FICA/TIER1 Medicare State Local

Worksheets: Basic Data > General and Dependents; Wages, Salaries and Tips; Rel/Rev of Claim to Exemption for Child (Form 8332) Forms 1, 1A, IRS-W2 and S-37

Provide the name of any person living with you who is claimed as a dependent on someone else's tax return

List the years that a release of claim to exemption is given for a dependent child not living with you ]]]]]]]]]]]

If any of your dependents were a victim of identity theft and you have contacted the IRS, provide the identity protection PIN issued to you by the IRS.

Note: Use this section to report any wages and/or salaries for which no Form W-2 was received.

2015

Dependent Information:

Wages and Salaries:

Include all copies of your current year Forms W-2

3A

Dependents and Wages

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500351 04-01-15 Payer Name

TSJ Account No. Prior Year Amount InformationIncluded (X

or )

2015

Interest Income

(12)

500361 04-01-15

TSJ Payer Name Account No. Prior Year Amount InformationIncluded (X

or )

2015

Dividend Income

(13)

500371 04-01-15

TSJ Payer Name Account No. InformationIncluded (X

or )

2015

Brokerage Statements

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<Client_ID>

Foreign Assets (1 of 3) 5C

You must complete this information if you meet any of the reporting thresholds below. This information is required to complete

Forms 8938 and FinCEN Form 114 (FBAR). Failure to disclose the required information to the U.S. Department of Treasury may

result in substantial civil and/or criminal penalties. For more information on foreign reporting, please visit

www.irs.gov/Businesses/Comparison-of-Form-8938-and-FBAR-Requirements.

If the aggregate value of your foreign financial accounts in which you have a financial interest in or signature authority over was

more than $10,000 at any time during 2015, complete SECTION A.

Foreign financial accounts include any financial account maintained by a foreign financial institution. This includes, but is not limited to,

a securities, brokerage, savings, demand, checking, deposit, time deposit, or other account maintained with a financial institution. A

financial account also includes a commodity futures or options account, an insurance policy with a cash value, an annuity policy with a

cash value, and shares in a mutual fund or similar pooled fund.

Signature authority is the authority of an individual (alone or in conjunction with another individual) to control the disposition of assets

held in a foreign financial account by direct communication (whether in writing or otherwise) to the bank or other financial institution that

maintains the financial account.

If the aggregate value of your foreign financial assets (including your foreign financial accounts mentioned above) in which you

have a financial interest was more than $50,000 on December 31, 2015 or more than $75,000 at any time during 2015, complete

SECTION B.

If you are married filing a joint return, the threshold is $100,000 on December 31 or more than $150,000 at any time during 2015.

Other foreign financial assets include any of the following assets that are held for investment and not held in an account maintained by a

financial institution. Examples of other foreign financial assets include the following, if they are held for investment:

- Stock issued by a foreign corporation

- A capital or profits interest in a foreign partnership

- A note, bond, debenture, or other form of indebtedness issued by a foreign person

- An interest in a foreign trust or foreign estate

- An interest rate swap, currency swap, basis swap, interest rate cap, interest rate floor, commodity swap, equity swap, equity index

swap, credit default swap, or similar agreement with a foreign counterparty

- An option or other derivative instrument with respect to any of these examples or with respect to any currency or commodity that is

entered into with a foreign counterparty or issuer

______________________________________________________________________________________________________________

SECTION A. FOREIGN FINANCIAL ACCOUNTS

Complete a separate column for each account. Use additional sheets if necessary.

Account 1

Account 2

1. Type of account (check one)

Bank

Bank

Securities

Securities

Other - Enter type ______________

Other - Enter type ______________

2. Check all that apply

Account opened during 2015

Account opened during 2015

Account closed during 2015

Account closed during 2015

Custodial account

Custodial account

Account jointly owned with:

Account jointly owned with:

Spouse

Spouse

Other

Other

Provide the name, address, and social security numbers of all joint owners

3. Name of financial institution

_______________________________

_______________________________

4. Mailing address of financial institution

_______________________________

_______________________________

City, state, postal code, and country

_______________________________

_______________________________

5. Account number or other specifying information

_______________________________

_______________________________

6. Value of account on December 31, 2015

$______________________________

$______________________________

(in U.S. dollars)

7. Maximum value of account during 2015

$______________________________

$______________________________

(in U.S. dollars)

(15)

<Client_ID>

Foreign Assets (2 of 3) 5D

Account 1 (continued)

Account 2 (continued)

8. Did you use a foreign currency exchange rate to

convert the value of the account into U.S. dollars?

Yes

No

Yes

No

If you answered "yes" to line 8, complete the following information:

(1) Foreign currency in which

account is maintained

_______________________________

_______________________________

(2) Foreign currency exchange rate

used to convert to U.S. Dollars

_______________________________

_______________________________

(3) Source of exchange rate used if not from U.S.

Treasury Financial Management Service*

_______________________________

_______________________________

*

You must use the U.S. Treasury Department's Financial Management Service foreign currency exchange rate.

You can find this rate on www.fiscal.treasury.gov

9. Are there any tax items attributable to this account

(ie. income, gain or loss, deductions, or credits)?

Yes

No

Yes

No

If you answered "yes" to line 9, complete the following information

(attach any supporting documentation)

:

(1) Interest income

$______________________________

$______________________________

(2) Dividend income

$______________________________

$______________________________

(3) Royalties income

$______________________________

$______________________________

(4) Other income

$______________________________

$______________________________

(5) Gains (losses)

$______________________________

$______________________________

(6) Deductions

$______________________________

$______________________________

(7) Credits

$______________________________

$______________________________

______________________________________________________________________________________________________________

SECTION B. OTHER FOREIGN FINANCIAL ASSETS

Complete a separate column for each asset. Use additional sheets if necessary.

Asset 1

Asset 2

1. Description of assets

_______________________________

_______________________________

If the asset is stock or securities, include the class or issue of the stock or securities

2. Account number or other specifying information

_______________________________

_______________________________

3. Was the asset acquired in 2015?

Yes

No

Yes

No

If yes, provide the date acquired

_______________________________

_______________________________

4. Was the asset disposed of in 2015?

Yes

No

Yes

No

If yes, provide the date disposed

_______________________________

_______________________________

5. Is the asset jointly owned with your spose?

Yes

No

Yes

No

6. Value of asset on December 31, 2015

$______________________________

$______________________________

(in U.S. dollars)

7. Maximum value of asset during 2015

$0 - $50,000

$0 - $50,000

$50,001 - $100,000

$50,001 - $100,000

$100,001 - $150,000

$100,001 - $150,000

$150,001 - $200,000

$150,001 - $200,000

More than $200,000

More than $200,000

Enter value $__________________

Enter value $__________________

(16)

<Client_ID>

Foreign Assets (3 of 3) 5E

Asset 1 (continued)

Asset 2 (continued)

8. Did you use a foreign currency exchange rate to

convert the value of the asset into U.S. dollars?

Yes

No

Yes

No

If you answered "yes" to line 8, complete the following information:

(1) Foreign currency in which

asset is denominated

_______________________________

_______________________________

(2) Foreign currency exchange rate

used to convert to U.S. Dollars

_______________________________

_______________________________

(3) Source of exchange rate used if not from U.S.

Treasury Financial Management Service*

_______________________________

_______________________________

*

You must use the U.S. Treasury Department's Financial Management Service foreign currency exchange rate.

You can find this rate on www.fms.treas.gov/intn.html.

9. Is the asset stock of a foreign entity or an interest

Yes - Go to line A

Yes - Go to line A

in a foreign entity?

No - Go to line B

No - Go to line B

Line A - If yes, report the following information:

(1) Name of foreign entity

_______________________________

_______________________________

(2) Type of foreign entity

Partnership

Partnership

Corporation

Corporation

Trust

Trust

Estate

Estate

(3) Is the foreign entity a PFIC?

Yes

No

Yes

No

(4) Mailing address of foreign entity

_______________________________

_______________________________

City, state, postal code, and country

_______________________________

_______________________________

Line B - If no, report the following information:

(1) Name of issuer or counterparty

_______________________________

_______________________________

(2) Check if information is for:

Issuer

Counterparty

Issuer

Counterparty

(3) Type of issuer or counterparty

Partnership

Partnership

Corporation

Corporation

Trust

Trust

Estate

Estate

(4) Check if issuer or counterparty is a

U.S. person

Foreign person

U.S. person

Foreign person

(5) Mailing address of issuer or counterparty

_______________________________

_______________________________

City, state, postal code, and country

_______________________________

_______________________________

10. Are there any tax items attributable to this asset

(ie. income, gain or loss, deductions, or credits)?

Yes

No

Yes

No

If you answered "yes" to line 10, complete the following information

(attach any supporting documentation)

:

(1) Interest income

$______________________________

$______________________________

(2) Dividend income

$______________________________

$______________________________

(3) Royalties income

$______________________________

$______________________________

(4) Other income

$______________________________

$______________________________

(5) Gains (losses)

$______________________________

$______________________________

(6) Deductions

$______________________________

$______________________________

(17)

500161 10-01-15

Yes No

2015 Amount 2014 Amount

Description 2015 Amount 2014 Amount

2015 Amount 2014 Amount

Description 2015 Amount 2014 Amount

Worksheet: Business > General, Income and Cost of Goods Sold Forms C-1, C-2 and C-3

]]]]]]]]]]]]]] ]]] TSJ ]]]]]]]]]]]]]]]]]]]]]]]]] Employer ID number

Street address

City, state, ZIP or postal code, and country Method of inventory

Method of accounting

]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]] ]]] ]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]

Did you dispose of this business? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, what was the disposition date? (Mo/Da/Yr)

Was there a change in determining quantities, costs or valuations between opening and closing inventory? ]]]]]]]]]]]]]] Were you involved in the operations of this business on a regular, continuous and substantial basis?

Have you prepared or will you prepare all required Forms 1099?

]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Health insurance premiums paid for yourself and your dependents ]]]]]]]]]]]]]]]]]] Include all Forms 1099-K

Payment card and third party transactions:

Include all Forms 1099-MISC Miscellaneous income:

Other Income:

Other gross receipts or sales Less returns and allowances

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Beginning inventory ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Purchases less cost of items withdrawn for personal use

Cost of labor (do not include amounts paid to yourself) Materials and supplies

]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Other costs of goods sold:

Ending inventory ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Name of Business:

Principal Business or Profession:

Business Questions for 2015:

Income:

Cost of Goods Sold:

(18)

500162 04-01-15

2015 Amount 2014 Amount

Description 2015 Amount 2014 Amount

X if

not new Acquisitions - Description Date Acquired(Mo/Da/Yr) Cost

Dispositions - Description Date Acquired(Mo/Da/Yr) Cost (Mo/Da/Yr)Date Sold Selling Price

Worksheet: Business > Expenses and Gains and Losses > Business Property, Casualties and Thefts Forms C-1, C-2, C-4, D-2, DP-1, DP-2 and DP-3

]]]]]]]]]]]]]] ]]]

Advertising ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Car and truck expenses

Parking fees and tolls Commissions and fees Contract labor

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Employee benefit programs and health insurance (other than pension and profit-sharing plans) Insurance (other than health)

Interest - mortgage (paid to banks, etc.) Interest - other

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Legal and professional fees

Office expense

Pension and profit-sharing plans

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]] Rent or lease - vehicles, machinery and equipment

Rent or lease - other business property Repairs and maintenance

Supplies (not included in Cost of Goods Sold)

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Taxes and licenses

Travel

Meals and entertainment Utilities

Wages

Dependent care benefits

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Name of Business:

Principal Business or Profession:

Expenses:

Other Expenses:

Property and Equipment:

Include a list if more space is needed

(19)

500163 04-01-15

Yes No

If you are an employer who provides vehicles for use by employees:

Yes No

Vehicle 1 Vehicle 2

2015 Miles 2014 Miles 2015 Miles 2014 Miles

Mileage:

2015 Amount 2014 Amount 2015 Amount 2014 Amount

Actual Expenses:

Worksheet: Business > Auto Information, Depreciation and Listed Property Questions Forms C-4 and C-5

]]]]]]]]]]]]]] ]]]

Do you have evidence to support your deduction? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, is the evidence written? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you have evidence to support the business use percentage claimed on listed property? ]]]]]]]]]]]]]]]]]]]]]]] If Yes, is the evidence written? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees? Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? ]] Do you treat all use of vehicles by employees as personal use?

Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

vehicles and retain the information received? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you meet the requirements for qualified demonstration use by maintaining a written policy statement that prohibits

vehicle use by individuals other than full-time vehicle salespersons, use for personal vacation trips, storage of

personal possessions in the vehicle and limits the total mileage outside the salesperson's normal working hours? ]]]]]]

Description of vehicle Date placed in service

Do you (or your spouse) have another vehicle available for your personal use? Was your vehicle available for use during off-duty hours? ]]]]]]]]]] ]]]]](Mo/Da/Yr) Yes Yes No No Yes Yes No No ]]]]]]]]]]]]] Total miles

Total business miles

Total commuting miles for the year ]]]]]]]]]]]]]]]]

]]]]]]]]]] ]]

Gasoline, oil, repairs, insurance, etc Interest

Taxes

Fair market value of leased vehicle Vehicle rentals/leases ]] ]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]] ]] ]]]]]]]]]

2015

Name of Business:

Principal Business or Profession:

Listed Property Questions for 2015:

Vehicle:

Business Expenses - Vehicle and

(20)

500166 04-01-15

2015 2014

Yes No

Direct Expenses Indirect Expenses

2015 Amount 2014 Amount 2015 Amount 2014 Amount

Description Direct Expenses Indirect Expenses

2015 Amount 2014 Amount 2015 Amount 2014 Amount

Name of Individual to Whom

Mortgage Interest Was Paid Number of IndividualIdentification Address of Individual to Whom Mortgage Interest Was Paid

Worksheet: Business > Business Use of Home Form M-15

]]]]]]]]]]]]]] ]]]

Square footage of home used exclusively for business Total square footage of home

Total hours home was used for day care during the year

]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]

Was your home used for day care purposes for the entire year?

Were improvements made to the home and/or home office since the time you began using the home for business?

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]

Direct expenses benefit the business part of your home.

Example: Cost of painting or repairs made to the specific area or room used for business. Indirect expenses are required for keeping up and running your entire home.

Example: Real estate taxes.

Casualty losses

Deductible mortgage interest paid to:

]]]]]]]]]]]]]]]]]] Financial institutions

Individuals

]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]] Real estate taxes

Insurance

Qualified mortgage insurance premiums

]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]] ]]]] Repairs and maintenance

Utilities Rent

]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Name of Business:

Principal Business or Profession:

Partial Use of Your Home for Business:

Expenses:

Enter all expenses at 100 percent

Other Expenses:

Seller-Financed Mortgage Interest Information:

(21)

500171 06-17-15

Yes No

TSJ Kind of Property and Description AcquiredDate

(Mo/Da/Yr)

Date Sold (Mo/Da/Yr)

Gross Sales Price (Less Commissions)

Cost or

Other Basis Federal TaxWithheld State TaxWithheld

TSJ Property Description (Mo/Da/Yr)Date Sold Principal Received2015 Principal Received2014

Worksheets: Gains and Losses > Stocks, Securities and Other Non-Passive Transactions and Installment Sales > General and Schedule of Receipts / Collections

Forms D-1, D-5 and D-6

Did you have any of the following during the year?

Mutual fund transactions ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Exchange of any securities or investments for something other than cash

Sales of inherited property

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Sales of any stock or stock options at a loss and purchases of the same or substantially similar stock or options 30 days

before or 30 days after the sale ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Commodity sales, short sales or straddles ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Reinvestment of the proceeds of the sale of a publicly traded security into an SSBIC interest ]]]]]]]]]]]]]]]]]]]]]] Reinvestment of the proceeds of the sale of qualified small business stock in other qualified small business stock ]]]]]]]]]] Debts that became uncollectible ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Securities that became worthless ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Sale of any property where you will receive payments in future years ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

A B C D E F G H

A B C D E F G H

2015

Gains or Losses from Sales of Stocks, Securities and Other Capital Assets:

Include all Forms 1099-A, 1099-B, 1099-S and copies of mutual fund statements for the year

Installment Sales: Do not include interest received in principal amount

Sales of Stocks, Securities,

(22)

500181 04-01-15 Former Home Information:

Original Cost and Cost of Improvements:

Description Amount

Sale Expenses:

Description Amount

Miles Mileage:

Amount Transportation Expenses:

Worksheets: Gains and Losses > Sale of Your Home and Moving Expenses > Schedule of Expenses Forms A-12 and D-7

TSJ

Date acquired Date sold

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] (Mo/Da/Yr) (Mo/Da/Yr) ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Selling price ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Commissions, legal fees, advertising and other expenses.

Did you personally own and occupy the home for at least 2 of the 5 years preceding the sale?

If your spouse is deceased, did the sale occur within two years of the date of death and did your spouse live

]]]]]]]]]]]]]]] Yes No

in the home for at least 2 of the 5 years preceding the sale? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Yes No If you had a foreign mortgage on the above property, please provide the amount of the mortgage retired on the sale and the date the mortgage

was acquired or the date the mortgage was most recently renegotiated

TSJ

Were the moving expenses reimbursed by your employer?

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Yes No Enter reimbursements not included in wages on your Form W-2 ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Number of miles from old home to new workplace Number of miles from old home to old workplace Number of automobile miles in move

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Costs of transportation of household goods and personal effects Costs of travel and lodging (do not include meals or automobile expenses) Automobile expenses (gasoline, oil, etc.)

Meals (Pennsylvania only)

]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Sale or Exchange of Your Home:

Include the closing statements from the purchase and sale of your former and new homes

Moving Expenses:

(23)

500191 04-01-15 Rollover?

Yes No

IRA Questions for 2015:

IRA Values, Rollovers, and Distributions:

Contributions:

Name of Payer Distributions2015 Gross TaxableAmount Federal TaxWithheld State TaxWithheld Is this a 2014 GrossDistributions

Worksheets: IRAs, Pensions and Annuities Forms M-22, M-23 and IRS-1099R

TS ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Are you covered by an employer's retirement plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If no, is your spouse covered by an employer's retirement plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you want to limit your IRA contribution to the maximum amount deductible on your tax return? ]]]]]]]]]]]]]]]]

If no, do you want to contribute the maximum allowable amount to your IRA even though you may not qualify

for an IRA deduction? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you use any IRA as security for a loan this year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you have any transactions with any IRA during the year?

If Yes, explain.

Total value of all traditional IRAs on December 31, 2015 Outstanding rollovers on December 31, 2015

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Total distributions converted to Roth IRAs

Total retirement plans converted to Roth IRAs

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

IRA:

Contributions in 2015 for the 2015 tax return Contributions in 2016 for the 2015 tax return

Amount for 2015 you choose to be treated as nondeductible

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Roth IRA:

Contributions made for the 2015 tax year ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Individual Retirement Account (IRA):

Include copies of all Forms 1099-R

Include copies of all Forms 5498

Distributions:

Include all Forms 1099-R and any nontaxable distribution details

(24)

500195 04-01-15 Rollover?

TSJ Name of Payer Distributions2015 Gross TaxableAmount Federal TaxWithheld State TaxWithheld Is this a 2014 GrossDistributions

Taxpayer Spouse

Yes No Yes No

2015 Amount 2015 Amount

Contributions to:

Worksheets: IRAs, Pensions and Annuities; Keogh, SEP and Simple Plans Forms M-6 and IRS-1099R

Have you established a self-employed retirement or SIMPLE plan with

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] deductible contributions?

]]]]]]]]]]]]]]]]]]] Do you want to contribute the maximum amount allowed?

Simplified employee pension plan Defined benefit plan

Defined contribution plan SIMPLE plan

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Include all Forms 1099-R and any nontaxable distribution details

Pensions and Annuities:

Self-Employed Retirement Plan:

Include copies of all Forms 1099-R

(25)

500201 04-01-15

Yes No

2015 2014

2015 Amount 2014 Amount

Description 2015 Amount 2014 Amount

Description 2015 Amount 2014 Amount

Description 2015 Amount 2014 Amount

Worksheet: Rent and Royalty > General and Income, Other Income > Payment and Third Party Transactions and Miscellaneous Income Forms E-1 and E-2

TSJ

Type of property ]]]]]]]]]]]

]]]

Have you prepared or will you prepare all required Forms 1099? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Ownership percentage if not 100%

How many days was this property rented at fair market value?

How many days was this property used personally (including use by family members)?

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] %

]]]]]]]]]]]]]]]]]]] ]]]]]

Rents received Royalties received

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Include all Forms 1099-K Payment card and third party transactions:

Include all Forms 1099-MISC Miscellaneous income:

Other income:

2015

Location of Property:

Income:

(26)

500202 04-01-15

2015 Amount 2014 Amount

Description 2015 Amount 2014 Amount

Worksheet: Rent and Royalty > Expenses Form E-1

Advertising Auto and travel

Cleaning and maintenance

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Commissions

Insurance

Legal and other professional fees Management fees

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Mortgage interest paid to banks, etc.

Mortgage interest paid to individuals Other interest

Repairs

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Supplies

Taxes Utilities

Dependent care benefits

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Employee benefits ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Other Expenses:

2015

Location of Property:

Expenses:

(27)

500211 04-01-15

TSJ Entity Name Employer IDNumber Health InsurancePaid by Entity

TSJ Entity Name Employer IDNumber Health InsurancePaid by Entity

TSJ Entity Name Employer IDNumber

TSJ Entity Name Employer IDNumber

Worksheets: Fiduciary Passthrough, Fiduciary Passthrough (A), Partnership Passthrough, Large Partnership Passthrough, S Corporation Passthrough and Other Passthrough

Forms K-1 through K-12, IRS-K1 1065, IRS-K1 1120S and IRS-K1 1041

2015

Include all Schedules K-1

Partnership Income:

S Corporation Income:

Include all Schedules K-1

Estate and Trust Income:

Include all Schedules K-1

Real Estate Mortgage Investment Conduit (REMIC) Income:

Include all Schedules Q

Partnership, S Corporation, Estate, Trust

(28)

500231 04-27-15 Worksheets: Other Income > Miscellaneous Income, Social Security Benefit Statement, Certain Government Payments, Miscellaneous, Refunds

of State and Local Income Taxes and Alimony Received and Other Adjustments > Alimony Paid

TSJ TSJ

2015 Amount 2014 Amount 2015 Amount 2014 Amount

TSJ State City YearTax StateIncome Tax RefundLocal

TSJ Nature and Source 2015 Amount 2014 Amount

TSJ Recipient's Name Social Security No.Recipient's Received?Alimony 2015 Amount 2014 Amount

Forms M-1, M-2, M-3, IRS-1099G, IRS-1099MISC and IRS-SSA 1099

Taxable pensions and annuities received Nontaxable pensions and annuities received

]]]]]]] ]]]]] Federal withholding on pensions and annuities State withholding on pensions and annuities

]]]] ]]]]] Unemployment compensation received

Unemployment compensation repaid in 2015

]]]]]]]] ]]]]] Social security benefits received

Social security benefits repaid in 2015

]]]]]]]]]]]] ]]]]]]]]] Medicare premiums withheld

Tier 1 railroad retirement benefits received Tier 1 railroad retirement benefits repaid in 2015

]]]]]]]]]]]]]] ]]]]]] ]]] Taxable IRA distributions

Nontaxable IRA distributions

Total lump sum social security received

]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]] ]]]]]]]] Lump sum taxable social security

Other federal withholding Other state withholding

]]]]]]]]]]] ]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]

2015

Include Forms: W-2G, 1099-MISC, 1099-RRB, 1099-SSA, 1099-SA, 1099-LTC and 1099-G

Miscellaneous Income and Adjustments:

State and Local Income Tax Refunds:

Other Income:

Alimony Paid or Received:

(29)

500232 04-01-15 : >

TS 2015 Amount 2014 Amount

TS Description 2015 Amount 2014 Amount

Yes No

TSJ Nature and Source 2015 Amount 2014 Amount

Worksheets Health Savings Accounts and Other Adjustments Educator Expenses, Other Adjustments and Student Loan Interest; Student Loan Interest Statement > IRS 1098-E

Forms M-1, M-19, P-16 and IRS 1098-E

Contributions made for 2015

Distributions received from all HSAs in 2015

What type of coverage applies to your high deductible health plan? Self only Family Were any HSA contributions listed above also shown on your Form W-2?

Were all distributions from your HSA for unreimbursed medical expenses?

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse enroll in Medicare? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, what month did you enroll? What month did your spouse enroll?

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

2015

Educator Expenses: Deduction for amounts paid by educators of kindergarten through Grade 12

Health Savings Accounts (HSAs)

Other Adjustments to Income: Include all Forms 1098-E for Student Loan Interest Paid

(30)

500241 05-04-15

TSJ 2015 Amount 2014 Amount

2015 Amount 2014 Amount

TSJ Description 2015 Amount 2014 Amount

TSJ 2015 Amount 2014 Amount

TSJ Real Estate Taxes 2015 Amount 2014 Amount

TSJ Description 2015 Amount 2014 Amount

Worksheet: Itemized Deductions > Medical and Dental Expenses, Other Medical Expenses, Taxes Paid and Other Taxes Paid Forms A-1 and A-2

Prescription medicines and drugs Total medical insurance premiums paid *

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Long-term care expenses

Total insurance reimbursement

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Number of miles traveled for medical care ]]]]]]]]]]]]]]]]]]]]]]]]]]] Lodging

Doctors, dentists, etc. Hospitals

Lab fees

Eyeglasses and contacts

]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Taxpayer long-term care insurance premiums paid Spouse long-term care insurance premiums paid

]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]

* Do not include Medicare premiums or premiums deducted in computing taxable wages reported on a W-2.

Personal property taxes paid (include vehicle taxes) General sales taxes paid on specified items

]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]] Itemize real estate taxes by state.

If you purchased or sold your home in 2015, did you include any taxes from your closing statement in the amounts above? Yes No

2015

Medical and Dental Expenses:

Other Medical Expenses:

Taxes Paid:

Include copies of your tax bills

Other Taxes Paid:

(31)

500242 04-01-15

Yes No

TSJ Paid To

Did You Receive

Form 1098? 2015 Amount 2014 Amount

Yes No

TSJ Paid To ID Number 2015 Amount 2014 Amount

Name Address

TSJ Paid To

Did You Receive

Form 1098? 2015 Amount 2014 Amount

Yes No

TSJ 2015 Amount 2014 Amount

TSJ Paid To 2015 Amount 2014 Amount

Worksheet: Itemized Deductions > Home Mortgage Interest Paid to a Financial Institution and Deductible Points, Other Home Mortgage Interest Paid, Investment Interest Expense Deduction and Mortgage Insurance Premiums Forms A-3, A-4 and 1098MIS

If you purchased or sold your home, did you include any mortgage interest from your closing statement in the amount below? ]]] Did you refinance your home? (If Yes, enclose the closing statement.) ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

If Yes, how many years is your new mortgage loan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Did you purchase a new home or sell your former home during the year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, enclose the closing statements from the purchase and sale of your new and former homes.

If Yes, also, did you (or your spouse, if married) have an ownership interest in a principal residence in the US

during the 3 year period prior to the purchase of this home? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, did you (and your spouse, if married at the time of purchase) own and use the same home as a principal residence

in the U.S. for any 5 consecutive year period during the 8 year period ending on the purchase date of the new home? ]]]]

Premiums paid or accrued for qualified mortgage insurance.

Interest paid on money you borrowed that is allocable to property held for investment.

2015

Mortgage Questions for 2015:

Home Mortgage Interest Paid To Financial Institutions:

Other Home Mortgage Interest Paid:

Deductible Points:

Mortgage Insurance Premiums:

Investment Interest Expense:

(32)

Itemized Deductions - Mortgage Interest

14B

If the total mortgages on your residence(s) are greater than

$1,000,000

, please provide the following information on all

mortgages, lines of credits, or other borrowings against your home(s).

Loan #1

Loan #2

Loan #3

Primary residence

Bank

____________________ ____________________ ____________________

Account number

____________________ ____________________ ____________________

Principal balance at 1/1/2015

$___________________ $___________________ $___________________

Principal balance at 12/31/2015

$___________________ $___________________ $___________________

Secondary residence

Bank

____________________ ____________________ ____________________

Account number

____________________ ____________________ ____________________

Principal balance at 1/1/2015

$___________________ $___________________ $___________________

Principal balance at 12/31/2015

$___________________ $___________________ $___________________

Additional residence

Bank

____________________ ____________________ ____________________

Account number

____________________ ____________________ ____________________

Principal balance at 1/1/2015

$___________________ $___________________ $___________________

Principal balance at 12/31/2015

$___________________ $___________________ $___________________

(33)

500251 07-30-15

TSJ Organization or Description of Contribution 2015 Amount 2014 Amount

TSJ Conservation Real Property 2015 Amount 2014 Amount

TSJ Description 2015 Miles 2014 Miles

TSJ Description of Donated Property 2015 Amount 2014 Amount

Worksheet: Itemized Deductions > Contributions and 8283 - Noncash Charitable Contributions Forms A-5, A-6 and A-8

Include all Forms 1098-C or other documentation.

You cannot deduct a cash contribution, regardless of the amount, unless you keep as a record of the contribution a bank record (such as a canceled check, a bank copy of a canceled check, or a bank statement containing the name of the charity, the date, and the amount) or a written communication from the charity. The written communication must include the name of the charity, date of the contribution, and amount of the contribution. Clothes and household items donated must be in good, used condition or better in order to be deductible unless the item donated is worth more than $500 and you have the item's value appraised. Attach a copy of the appraisal. Include any vehicles donated to charity.

100% limit 50% limit

Number of miles traveled performing volunteer work for qualified charitable organizations

Include all documentation.

Include all Forms 1098-C or other documentation. TSJ ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

Description of the donated property Donee organization name

Donee organization address

]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]

]]

Date the property was acquired by the taxpayer (Mo/Da/Yr) ]]]]]]]]]]]] (Mo/Da/Yr) Date the property was donated

]]]]]]]]]]]]]]] Cost or basis of the donated property

Fair market value of the donated property ]]]]]]]]]]]]]

Which of the following methods was used to determine the fair market value? CAUTION: Generally, contributions in excess of $5,000 of similar property will require an appraisal (does not apply to marketable securities)

Appraisal Thrift shop value Catalog Comparable sale

Other - please explain ]]]]]]]]]]]]]]]]]]]]]]

Which of the following describes how this donated property was acquired?

Purchase Gift Inheritance Exchange

2015

Cash Contributions:

Noncash Contributions Totaling $500 or Less:

Noncash Contributions Totaling More Than $500:

(34)

500261 04-01-15

> >

TSJ 2015 Amount 2014 Amount

Examples:

TSJ Description 2015 Amount 2014 Amount

Worksheets: Itemized Deductions Miscellaneous Deductions and Gains and Losses Business Property, Casualties and Thefts Forms A-4 and D-2

Union and professional dues Tax preparation fee Professional subscriptions

Hobby expense (To extent of income) Safe deposit box

Uniforms and protective clothing Work tools Gambling losses Estate taxes ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

¥ Certain legal and accounting fees ¥ Investment expenses

¥ Custodial fees

¥ Employment agency fees ¥ Certain educational expenses

TSJ

Property description

Which of the following describes the type of property that sustained the casualty or theft loss? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]

]]]]]]]]]]]]]]]]]]]]]]]]]

Personal use due to Hurricane Katrina Personal use Business use Income producing Employee Use

Personal use attributable to a federally declared disaster between 2007 and 2009

Personal use attributable to Midwestern disaster area

Personal use attributable to Kansas disaster area Personal use attributable to insolvent or bankrupt financial institution losses on deposits Date acquired

Date damaged or lost

]]]]]]]]]]]]]]]]]]]] (Mo/Da/Yr) (Mo/Da/Yr) ]]]]]]]]]]]]]]]

Original cost or other basis ]]]]]]]]]]]]]]]]]]]]] Fair market value before casualty

Fair market value after casualty Cost of replacement

Insurance reimbursement ]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]

2015

Miscellaneous Itemized Deductions:

Other Itemized Deductions:

Casualty or Theft Loss:

Figure

Updating...

References